Republican Sen. Bill Cassidy of Louisiana, center, co-sponsor of an Obamacare repeal measure that could be headed for a vote next week, speaks to the media Tuesday, accompanied, at rear right, by Republican Sen. John Cornyn of Texas and, at far right, Senate Majority Leader Mitch McConnell of Kentucky.

Republican Sen. Bill Cassidy of Louisiana, center, co-sponsor of an Obamacare repeal measure that could be headed for a vote next week, speaks to the media Tuesday, accompanied, at rear right, by Republican Sen. John Cornyn of Texas and, at far right, Senate Majority Leader Mitch McConnell of Kentucky. (Alex Brandon, Associated Press)

To be or not to be for Ohio. That is the question Sen. Rob Portman has to answer now, amid the sea of troubles caused by the latest GOP maneuverings over health care.

The time for Hamlet-like waffling and empty gestures is over, Sen. Portman. Let your voice be counted for rationality, reason and Ohio. Say you will vote "no."

As early as next Monday, Senate GOP leaders have signaled they'll bring to the floor a last-ditch attempt to repeal the Affordable Care Act, aka Obamacare, via a simple majority vote under reconciliation measures that are about to expire.

The current repeal measure, sponsored by Sens. Lindsay Graham of South Carolina and Bill Cassidy of Louisiana, would, if anything, be worse for Ohio -- with its large Medicaid population -- than prior measures. It goes far beyond repeal to essentially eliminate all federal Medicaid payments to states and replace them with what amounts to block grants. Ohio would be one of the big losers under this approach.

Medicaid coverage for opioid treatments so critical in Ohio, epicenter of the epidemic? Eviscerated.

Health insurance for hundreds of thousands of lower-income Ohioans? Gone.

Basic health care protections for children and the elderly that long have underpinned Medicaid? On life support.

Only someone who puts party loyalty over loyalty to the Ohioans who elected him would agree to this. Portman, a suburban Cincinnati Republican, must choose not to be that politician. He must shelve his "Hamlet" imitations and immediately disavow this measure.

Republican Gov. John Kasich strongly opposes the plan, demonstrating once again that when the topic is health care, Kasich is one of the GOP's adults. Kasich recognizes the measure would be a disaster for Ohio and Ohioans.

Among the ways Graham-Cassidy would pound Ohio is by changing how the federal government determines how much Medicaid funding to give states. According to Avalere's analysis, "the bill would change the financing structure for the traditional Medicaid population from an open-ended approach to a fixed per-capita or block grant approach."

Now, federal aid to help states' federal Medicaid clients is determined by the cost of their health care. Graham-Cassidy would instead give states per-capita funding for traditional Medicaid clients regardless of medical conditions and needs.

To Kasich's lasting credit, he expanded Medicaid, as the ACA allows, to cover more low-income Ohioans. About 96,000 of those Medicaid expansion clients live in Cuyahoga County, with another 75,000 in surrounding counties.

Graham-Cassidy would reduce and ration that care with a per-capita approach that broadens funding, peanut-butter-like, to states that didn't expand Medicaid. Hence, Texas' bonanza.

Another result: Health care providers in Ohio would have to eat big losses as the measure opens a huge gap between health care coverage and health care needs. Some rural hospitals would be at risk of folding. Others might ration care to some patients.

These are among the reasons the American Medical Association opposes Graham-Cassidy, warning its provisions violate the sacrosanct medical precept of "first do no harm" and also "would allow insurers to charge unaffordable premiums" for those with pre-existing conditions.

About our editorials: Editorials express the view of the editorial board of cleveland.com and The Plain Dealer -- the senior leadership and editorial-writing staff. As is traditional, editorials are unsigned and intended to be seen as the voice of the news organization.

Have something to say about this topic? Use the comments to share your thoughts, and stay informed when readers reply to your comments by using the Notification Settings (in blue).